Radiological assessment in cervical spine myelopathy

Degenerative cervical myelopathy (DCM) is the most common cause of non-traumatic spinal cord dysfunction in adults, resulting from conditions such as cervical spondylosis, ossification of the posterior longitudinal ligament (OPLL), and disc degeneration. Radiological evaluation is essential to diagnosis, surgical planning, and prognosis. This review outlines the current role of imaging modalities, ranging from plain radiographs and computed tomography (CT) to magnetic resonance imaging (MRI), in the assessment of DCM. Plain radiographs and CT scans provide valuable information on cervical alignment, instability, and ossification patterns, while MRI remains the gold standard for evaluating spinal cord compression and changes in signal intensity. Advanced techniques, including diffusion tensor imaging (DTI), magnetic resonance spectroscopy (MRS), and functional MRI (fMRI), offer additional insights into spinal cord integrity and metabolic alterations, though their clinical application remains limited. A systematic and multimodal imaging approach enhances diagnostic precision, helps in surgical decision-making, and supports individualized treatment strategies in patients with cervical myelopathy.